In October 2003, the Georgia Division of Public Health (DPH) was notified of two patients from the same county with confirmed West Nile virus (WNV) disease who had received hemodialysis on the same day and on the same dialysis machine. The two dialysis patients (patients A and C) had the only confirmed cases of human WNV disease reported in their county in 2003. Review of the dialysis center's records indicated that another patient (patient B) had received dialysis on the same machine between these two patients on the same day. This report summarizes results of the epidemiologic investigation, which suggested that WNV might have been transmitted at the dialysis center. Hemodialysis centers should adhere strictly to established infection-control procedures to avoid WNV transmission through dialysis.

Patient A. The first patient, who received dialysis on the machine (machine A) in late August, was a man aged 77 years with a history of hypertension and end-stage renal disease (ESRD). Eight days after dialysis, patient A was hospitalized with a 48-hour history of fever, chills, confusion, and anorexia. Blood cultures were negative. Serologic testing of serum revealed IgM and IgG antibodies to WNV by enzyme-linked immunosorbent assay (ELISA) and a higher neutralizing antibody titer to WNV (1:1,280) than to St. Louis encephalitis virus (SLEV) (1:320). Patient A had not received a blood transfusion Patient C. The third and last patient to receive dialysis on machine A on the same day in late August was a man aged 60 years with a history of type 2 diabetes, hypertension, alcoholism, recent onset of ESRD, and prostate cancer. Nineteen days after his dialysis procedure, patient C was admitted to a local hospital with fever, chills, altered mental status, and cachexia. After admission, he had seizures and was intubated and placed on a ventilator. Analysis of cerebrospinal fluid (CSF) indicated a mild pleocytosis (67 white blood cells [62% polynuclear cells, 38% mononuclear cells] and five red blood cells/mm3) and an elevated protein level (122 mg/dL). Computerized tomography scans of the patient's brain on the second and tenth days of hospitalization revealed bilateral lacunar infarcts, white matter changes, and cortical and subcortical atrophy. Serologic tests of serum were positive for IgM and IgG antibodies to WNV by ELISA. The neutralizing antibody titer was higher to WNV (1:1,280) than to SLEV (1:20). Patient C had not received a blood transfusion